Cardiovascular disease (CVD) is a major cause of mortality around the world.1 In the United States, the age-adjusted mortality rate associated with CVD is 219.4 per 100,000 people.2 Recent studies suggest that one way to reduce the risk for CVD-related outcomes is to consume more omega-3 fatty acids, specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).3-5

While most patients and clinicians know what omega-3 fatty acids are, it is common to lump all omega-3s together into one category. However, recent research — as well as thousands of other studies — suggest that marine-based omega-3s (EPA and DHA) have the strongest association between intake and cardiovascular risk reduction.4

Unfortunately, 80% of people worldwide are not getting enough EPA and DHA omega-3s in their diets.3  This knowledge gap indicates the importance for clinicians to know the difference between omega 3 agents so they can counsel their patients accordingly.

Omega-3 research published in Mayo Clinic Proceedings is the most comprehensive analysis to date on EPA and DHA dosage and its role in cardiovascular prevention, with a review of 40 clinical trials.4 The authors found that EPA plus DHA supplementation is associated with a statistically significant reduced risk for:


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  • Fatal myocardial infarction (MI) (35%)
  • MI (13%)
  • Coronary heart disease (CHD) events (10%)
  • CHD mortality (9%)

The researchers also found that cardiovascular benefits appear to increase with dosage. Adding an extra 1000 mg of EPA and DHA per day reduced the risk for cardiovascular disease by 5.8%, and for heart attack by 9.0%. The study included dosages from 400 mg per day up to 5500 mg per day.4

“People should consider the use of omega-3 supplements to help them reach total daily intake of 1000 to 2000 mg as a relatively low-cost, high-impact way to improve heart health with few associated risks,” said Carl J.  Lavie, MD, a cardiologist at John Ochsner Heart and Vascular Institute, New Orleans, and a co-authors of the study.4

How Much Do Patients Need?

According to the Mayo Clinic Proceedings study, as well as a recently published study from Harvard University on omega-3 intake and cardiovascular benefits,5 daily omega-3 intake upwards of 1000 mg would be an effective goal. However, knowing that the average intake of EPA and DHA omega-3s in the US is about 100 mg per day, any increase is an improvement.

One way to help patients meet intake goals is to get their omega-3 blood levels tested using a finger-prick test. Desirable levels of omega-3 fatty acids is around 8%.6 Clinicians can counsel patients accordingly based on their baseline number.

To help patients get more EPA and DHA omega-3s, have them:

  • Increase the amount of fatty fish in their diets.
  • Consider an omega-3 supplement. In addition to eating healthy fish, a daily omega-3 supplement helps maintain steady blood levels of EPA and DHA.
  • Add some omega-3 formulated foods to their diets, such as DHA-fortified milk and omega-3 eggs. While most foods fortified with EPA and/or DHA usually offer a small amount per serving, every little bit helps.6

Robyn L. Kievit, FNP-BC, RDN, CSSD, CEDRD, has worked as a nurse practitioner and dietician, and currently is a nutrition counselor focusing on eating disorders, sports nutrition, and primary care.

References

  1. World Health Organization. Cardiovascular disease.  WHO website. Accessed October 28, 2020. https://www.who.int/cardiovascular_diseases/about_cvd/en/
  2. Virani SS, Alonso A, Benjamin EJ, et al. Heart disease and stroke statistics — 2020 update: a report from the American Heart Association. Circulation. 2020;141(9):e139-e596.
  3. Stark KD, Van Elswyk ME, Higgins MR, Weatherford CA, Salem N. Global survey of the omega-3 fatty acids, docosahexaenoic acid and eicosapentaenoic acid in the blood stream of healthy adults. Prog Lipid Res. 2016;63:132-152.
  4. Bernasconi AA, Wiest MM, Lavie CJ, Milani RV, Laukkanen JA. Effect of omega-3 dosage on cardiovascular outcomes: an updated meta-analysis and meta-regression of interventional trials. Mayo Clinic Proc. 2020. Published online September 17, 2020. https://doi.org/10.1016/j.mayocp.2020.08.034.
  5. Hu Y, Hu FB and Manson JE. Marine omega-3 supplementation and cardiovascular disease: and updated meta-analysis of 13 randomized controlled trials involving 127,477 participants. J Am Heart Assoc. 2019;8(19):e013543.
  6. National Institutes of Health. Omega 3 fatty acids. NIH website. Accessed November 4, 2020. https://ods.od.nih.gov/factsheets/Omega3FattyAcids-HealthProfessional/#ref